Pain.

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—View from the far side of the recliner

Alright, I finally got this pain thing written. It took longer than most posts, is probably a lot heavier on information and less on the humor. At least what I consider funny.

Pain.

And then there is pain, the phenomena that led me to hypnotherapy in the first place. Pain is huge! A large part of the pharmaceutical industry is based on pain, as are all kinds of non-prescription devices, lotions, balms, powders, supports, pads, wraps, hot packs, cold packs, liquids and pills. Many, if not most of the visits to physicians, massage therapists, physical therapists and chiropractors are for pain. Pain is good for business. Pain is business. It certainly has paid a chunk of my bills since becoming a PT in 86.

You can’t trust Pain.

Generally people try to avoid pain. There are situations when some people seek physical pain to relieve psychological suffering but that is the exception. Pain is (kind of) nature’s way of saying “Don’t do that” and (naturally) “this going to hurt you worse than it is going to hurt me”. Nature can be kind of a jerk sometimes. It turns out that pain can be worse than the engine light on a dashboard for giving an accurate warning of when something is seriously wrong.  Stubbing a toe, stepping on a nail, hitting your thumb instead of a nail, hangnails, cold sores, dental work, touching something hot, and first degree burns, all of that can really hurt a lot and yet doesn’t cause serious tissue damage and won’t kill you. There are many things that don’t cause pain, especially in the early stages that are life threatening. Cancer, aneurisms, parasites, high blood pressure and infections often begin unannounced and continue to develop silently until it is too late or at least much harder to treat.  Where is pain when you need it?

The way senses work.

For what are usually considered senses, touch, hearing, smell, taste and vision, if the sense organs themselves and the wiring is intact, the stimulus pretty much comes through without a lot of interpretation. The stimuli come from specific sources; light and sound waves, tasty and smelly molecules, heat, cold and pressure. Once the stimulus is received then all kinds of associations can happen. When I smell musty dampness I have a happy association with my grandparents’ basements and diesel fumes I associate with great car trips. When someone else smells musty dampness or diesel fumes there are likely to be very different associations. Basically it seems that no matter what you are thinking or feeling prior to the stimulus, orange is orange both the color and the taste, the same type of coffee smells the same. Whether you focus on the stimulus or not, it pretty much gets through unaltered. The same stimulus tends to be perceived as being the same at different times and by different people. The color orange is the same today and tomorrow and to you and me.

Pain is different.

Pain is processed through a number of places in the brain and there are different types of pain, acute vs. chronic, pulsing, burning, crushing, tingling, hot, cold, numbing, pinching, sharp and dull. Believe me there is a very long list. Pain can be very localized, over a larger area or seem to be in the entire body. Unlike the specific stimuli for the “regular” senses, pain is much more varied. Pain is a phenomena in which the same stimulus is experienced differently at different times and by different people. The amount of other stimuli you are receiving at the same time can affect the amount of or even if pain is perceived. Sitting in a chair totally absorbed in the sights and sounds of great movie while eating popcorn is a totally different pain experience than sitting in the same chair without any other stimulation. What you are thinking and the mood you are in have a huge effect on pain perception.

The Shot.

Not your happy place.

Think about a child that going to get a shot. You may have been through this one yourself. If the kid’s parents are stressed and keep saying “be brave, this isn’t going to HURT”, the kid is thinking “why do I have to be brave if it isn’t going to HURT?”Big brothers can always make things worse by saying “I bet you’re going to cry, I had a shot and it made my arm black and blue and the needle was this BIG!”. The kid has to sit there in a drab room for a very, very long time (for a young kid just sitting still for five minutes is torture). Nobody is talking about happy things, or singing songs, playing with or reading to the child sitting. The adult/s may even be checking or talking on their cell phones. Someone might suddenly remember about the time that Uncle Bob passed out when he saw the needle. The nurse comes in couldn’t care less, barely says anything other than “sit still”. Poor kid. That shot is really going to hurt.

A better place.

Now imagine the same kid in a room with interesting decorations, maybe music or even kid friendly videos, parents and siblings talking about pleasant things, maybe enjoyable activities that are going to happen after the visit to the doctor. During the wait the child is encouraged to move around maybe playing with a toy. Someone might let the child play on a cell phone. When the nurse arrives he/she talks to the child in a nice unhurried way. When it is time for the poke someone distracts the child in a direction away from the nurse perhaps with a picture and/or story about when the kid was feeling especially good and strong. Wow! Done already? Let’s go do ____ (whatever is the next happy thing on the list).

Same shot but a totally different experience. Child birth, surgeries, dentist appointments and chemo/radiation therapy can be experienced in very different ways.

It’s all in the Mind.

Much of pain is fear, fear that you won’t be able to deal with the pain, expectations that a procedure will be painful, perhaps based on exaggerated stories, TV, movies or even an imagination gone wild. Contrary to the old saying “ignorance is bliss”, ignorance can actually be fear which leads to increased pain. Sometimes ignorance is just ignorance, but I don’t know. Just knowing that you can have control over pain gives you some control over pain. Watching a video of a woman calmly delivering a baby using hypnosis can both negate unrealistic fear and set up the expectation that it is possible to have a baby in a natural and relatively relaxed manner. There are many techniques that can help deal with pain. In addition to education I often use breathing techniques, visualization and hypnosis to give my clients the tools they need to control or eliminate pain.

Etcetera.

In a hypnotic trance a person can eat an onion thinking that it is an apple, feel one arm become weightless while the other becomes so heavy it can’t be lifted, that the room becomes very hot or cold, hear or smell things that aren’t there or can’t see. Pretty impressive. The mind’s grasp on the senses can be tricked and that can be both entertaining and a good demonstration of the reality of the effect of hypnosis. But as far as making a real improvement in someone’s life tricks don’t count for much. The real deal, the thing that gets me so excited about hypnotherapy and the other techniques is the power they give people to achieve their goals, overcome stress and anxiety. The thing that started the whole thing for me was working with people in chronic pain. I’ve used the techniques on myself (as blathered about in previous posts) and many patients/clients. It’s all in the mind and it’s real.

Next time someone says “It’s a pain”, you can say “yeah but it doesn’t have to be”.

Next post will probably be about something interesting called Enneagram.

Feel free to contact me with any comments, requests and of course if you know someone who might be interested in these posts please send them on.
Thanks,
Don Berlyn

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First Session: What happens behind the closed door?

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—View from the far side of the recliner

Typically we have already had an extensive conversation about why they are calling me. These conversations are usually on the phone but sometimes a person would like to meet in person, in that case we meet in my office or my favorite coffee shop. In either case the initial consultation is free. Almost always the issue is something that is appropriate for my services. I then explain broadly what techniques might be employed.
At the beginning of the initial session the client fills out a simple and pretty brief intake form. In addition to basic personal information; name, phone numbers, email and mailing addresses, age, medical condition/s, relevant medications, counseling and hypnotherapy experience/s and referral source. The second page is information on the current issue/s, which is only half a page. The bottom of that page is agreements, the most important of which is to be an active participant in the process as a co-therapist. The last page is a list of the only conditions that any information from our sessions will be released other than to the client. In seven plus years I have never had to release any information on anyone. I always tell the client that my notes are both minimal and illegible. This maybe a comfort or not but it is definitely true.
Next the client’s issues, goals and relevant history are discussed in depth. During this conversation the client often makes discoveries, has insights and uncovers long lost memories. Depending on the issue/s most of the therapy happens before I do anything other than listen intently and ask key questions.
Part three is a discussion of the techniques of that I use only about half of which is formal hypnosis, the rest is breathing, visualization, NLP and various other techniques. NLP is Neuro Linguistic Programming which is not as scary as it sounds. Hypnosis is explained in terms of what it is and isn’t.
Part four is development of suggestions using the client’s goals and language. This is a very collaborative process in which I typically write out some suggestions, then run the content past the client until the suggestions align with the client’s goals then we fine tune the language to the point that it sounds like the client talking to themselves.
Part four is the instruction and practice of techniques then a transition into hypnotic trance. An emphasis of this stage is that the client is able to use all of the techniques, including an abbreviated version of hypnosis with suggestions independently.
Part six is a review of the session including the trance and techniques for independent use. Recommendations are made questions are answered, the client is asked to contact me at any time for support or with questions and to schedule. Scheduling, unless it is a medical, pain or pressing issue future sessions are scheduled at least a week later to give the patient time to practice the techniques and to observe any changes in their issues.
Almost always there is a fair amount of laughter, which is therapeutic, sometimes tears, usually the client more than me, which is therapeutic too.
I schedule the first session for two hours, subsequent ones for an hour to make sure there is no time pressure. Rarely sessions go past the scheduled time which works out alright usually because I try to leave time between appointments.
The charges are per session not time. Taking time and money considerations off the table makes things more relaxed for everyone. Besides turning to watch the meter hurts my neck.
I’m still working on the pain post, want to make sure that the wording is just right. I’ve had two radio info ads on two local stations and it’s time to write a couple of new ones. It is so strange to hear your recorded voice. I continue to work on the certification for the Blissborn hypnosis program for the birth process to replace the program I was using. I will begin with a real pregnant who will be even more really pregnant in about a month.

Feel free to contact me with any comments and of course if you know someone who might be interested in these posts please send them on.
Thanks,
Don Berlyn

Why I Love that there is (almost) no paperwork with Hypnotherapy!

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What good is having a blog if you can’t rant? Well this is my blog and here is my rant.
I just spent a couple of hours today trying to finish a report for a Medicare Physical Therapy patient and I’m still not done. This patient has a long list of relatively common medical issues but also on that list is a rare neurological condition which had been misdiagnosed as another more common neurological disease. I was seeing this patient for a simple activity related neck and shoulder pain complaint with an onset about four months ago. In a rational system the initial evaluation and medical history should have been a thirty minute write up, a page and a half at the most. My patient didn’t understand that further Physical Therapy would have to be approved and that she isn’t allowed to pay us until we have billed her Medicare plan and secondary. It is not clear if this patient wants to continue or will go somewhere else. She is somewhat confused so I am somewhat confused.
Welcome to crazy town. All medical records now have to be electronic. This means that if there are nude pictures in your medical records they will likely be leaked any day now. Hope you look good in that blue gown with the open back! If hackers can get into secure sites of defense companies, banks and government agencies what chance is there that the people that brought you HealthCare.gov will do a better job. Even if a site isn’t hacked, theoretically anyone in a medical office or insurance company that has access to your records can help themselves to that information. Theft of information in the electronic age can happen so much faster and in incredible amounts compared to the old days of paper medical billing and tabbed patient files.
Medicare requires an incredible amount of irrelevant information. Levels of disability or function need to be chosen somewhat arbitrarily from lists. The function limits are from redundant, overlapping lists. The time spent doing all of this, is time not spent treating patients and is not reimbursed. The costs of the various programs and the monthly fees to use the documentation to be in compliance are an added burden. The effect of all this on medical providers has not been pretty. I know a number of family or general practice physicians who have closed their practices and either retired, become hospitalists or gone to work for large hospital based clinics. It is very difficult to find a physician that will take a new Medicare patient. It is harder and harder to make it as a small practice. I think something is being lost in the process and it’s not just old magazines in the waiting room.
A friend of mine who is a Physical Therapist and Certified Hand Therapist, recently became a Licensed Massage Therapist, teaches a bit at a massage school and runs a bed and breakfast. This very experienced, skilled specialist is only occasionally seeing hand patients and won’t bill insurance companies. The non-treatment parts of healthcare are taking the pleasure out of serving people. The reason people go into healthcare (hopefully) is to work with patients and not be mind-melded with an uncaring electronic bureaucracy.
One of the beauties of Hypnotherapy that I really appreciate, is the ability to really help people achieve their goals without dealing with insurance, paperwork, billing or bureaucracy. It is so simple, the client wants to make a change, comes up with a goal, determines who or what can help him/her achieve that goal, makes an appointment, receives the service and pays for the service. Just a person wanting to get somewhere, hiring another person to help them get there. Strange no one thought of that way of doing healthcare before.
I love that about Hypnotherapy and would like to see it happen with Physical Therapy.
Next week I’ll write about something. I got off track this week due to my paperwork issues. I’ve actually had a couple of hypnotherapy sessions on this curse of mine. Guess I need some more work on that, maybe a lot more work.
Feel free to contact me with any comments and of course if you know someone who might be interested in these posts please send them on.
Thanks,
Don Berlyn

The Difference and Similarity between Hypnosis and Meditation

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One of the most frequent questions I get asked is “what is the difference between hypnosis and meditation?”. My answer is that they are similar and different. My own experience with formal hypnosis over the last seven years is fairly extensive in terms of varied flavors, the number of sessions, as both the hypnotherapist and the client. I do not teach formal meditation and don’t claim to be an expert. I have practiced meditation in a formal way inconsistently over the last ten years. I’ve had some amazing experiences of peace and at times simply being gone. I’ve basically used focusing on breathing, on nature or music and once a walking meditation. Just as in hypnosis there are different techniques in meditation.

One similarity is that in both hypnosis and meditation the conscious mind can become very quiet. Both can involve the visualization of objects and scenes that exist only in the mind in the current moment. In hypnotherapy this could be seeing/experiencing oneself in the future having recovered from a health/medical issue, being at an ideal weight, hitting a golf ball just right, being comfortable flying in a plane, having achieved basically any goal. In some traditions, like Mahayana Buddhism of which Tibetan Buddhism is a part, meditation might include visualizing a complex mandala*, various bodhisattvas**, world peace, the liberation of all being from suffering. Perhaps the main difference that I can think of, is that in hypnotherapy the experience is guided at some level by another person while meditation is internally guided.

There is a great book about Meditation; Meditation for Dummies by Stephen Bodian. I love the “for Dummies” books that I’ve bought. I’m thinking about writing a Living my Life for Dummies.

 

For my clients that are interested, I certainly encourage meditation in addition to any techniques that have been recommended as part of their sessions. The health benefits of meditation have been studied extensively.

 

A way to make meditation more user friendly and perhaps more effective for some people.

Meditation can be a daunting experience in the way that it is commonly presented. One version is sitting on a cushion for extending periods of time. Trying to have a quiet mind rather than the “monkey mind” of internal chatter is a challenge.

At The HypnoThoughts Live conference, I attended a seminar on Hope Coaching/Mindful Hypnosis. (For information on Hope Coaching visit www.mindfulhypnosiscoach.com .) One of the speakers, Michael Ellner brought up an idea which is great. Instead of one long meditation session, how about several ones of a few minutes. Stephan Bodian in his Meditation book also mentions brief sessions. Just like with exercise, many people say that they don’t have the time but almost everyone has six minutes or so here and there throughout the day. Starting first thing in the morning with a meditation can set the tone for the day. With exercise if the goal is to burn calories, then it doesn’t matter if you walk one mile a day or four, quarter mile walks, the calories burned are the same. There are things that are likely beneficial in the long periods of sustained meditation and that maybe something for people to aspire to. For people who are in pain, who may not be able to sit in one position for long, whose lives feel so chaotic, who are stressed and anxious, the small bouts of meditation may bring a sense of peace and increased comfort.

 

*for a cool website to explore the concept of mandalas see: www.graphics.cornell.edu/~wbt/mandala .

**for information and images of bodhisattvas an internet search will result in at least a couple of different definitions and many varied images. But you’ll have a better idea of the concept of bodhisattva than you did before. Especially if you had no idea to begin with.

 

Next time I’ll write about hypnosis/trance and body work.

Feel free to contact me with any comments and of course if you know someone who might be interested in these posts please send them on.

Thanks,

Don Berlyn

Hypnosis Conference and some differences between the worlds of Physical Therapy and Hypnosis

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I attended a hypnosis conference, HypnoThoughts Live in Las Vegas from last Friday through Sunday. The first thing I noticed while walking through the slot machine area of the smoke filled first floor that even early in the morning there were a lot of mainly older people, many appearing physically disabled, sitting in front of the blinking machines with glassy eyed, blank expressions. Wow. What a sad display of hypnosis and not even to the second floor conference center yet.

The conference itself was great. (Probably not the best food I’ve had at a conference but I wasn’t there for the food.) The interaction with other attendees and the presentations/lectures were excellent. I learned a technique that I included in the session with a client less than an hour after driving into town. That is the mark of a great seminar.

I was definitely in a trance in the exhibit room. I spent way more than I had planned including 15 copies of what seems a really good book about hypnotherapy. Now I have to figure out who to give them to that would actually read them. It would be nice if they were to become a client and/or refer someone.

This conference itself was interesting in that the world of hypnosis is so different from my home world of physical therapy. Physical therapy is a body of knowledge and a defined practice. In physical therapy everything is about treating patients or researching or teaching about treating patients. The education is rigorous, there are board exams and licensure in every state. There is typically a state board to insure that PTs are following the rules. There is one national organization under which each state is one chapter and under the national organization there are sections for specialties such as orthopedics, pediatrics or neurology.

Hypnosis is a tool. Anyone can use the tool. I can hold a power saw but I am NOT a carpenter. It is the Wild West, even on the East coast. Anyone can call themselves a hypnotherapist and charge whatever they can get. It doesn’t matter if they watched U tube, read a book, took a weekend course or went to a seven week intensive program like I did. (Just to brag, I’ve gone to two additional hypnotherapy courses of two weeks each, done some continuing education and read extensively on hypnotherapy related material.) There is no licensure, board exams or state boards. There appear to be many organizations. I belong to the American Council of Hypnotist Examiners ACHE) which seems to be mainly a western state organization and certified the school that I attended which has since started its own organization. I have attended one ACHE conference which was pretty interesting.

When it comes to being an entertainment hypnotist, it seems there is not even a pretense of being regulated. Just put “The Great” in front of your name, get a rabbit and a hat and you are good to go. Just kidding, not everyone uses a rabbit. Really there is no reason for stage hypnotists to be regulated, the market does that. If you are not entertaining you are gone faster than a bag pipe player out of tune (how would you know?).

What was really special about this conference is that everyone was invited, hypnotherapists, entertainers, people who just were curious and some folks looking for craps tables. Several different organizations were represented. It was all love and peace. Kind of like Woodstock for Hypnosis, think hot and dry instead of wet and muddy. Elevator music vs. amazing. Naturally induced trance (no ODs) vs. chemically induced trance (there were ODs). The price was very reasonable and despite the food, I’m looking forward to being there next year.

Next post I’ll rattle on about the difference and similarities between hypnosis and meditation. I’ll describe the technique I learned at the conference that I used with my client. It’s a way to make meditation easier/more user friendly for most people. The Dali Lama is already cringing, while smiling peacefully.

Thanks,

Don

It’s alright to get paid isn’t it? Another Learning Experiences

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It’s alright to get paid isn’t it?

Strange concept. It makes sense that if you do some service for someone you should get paid. Nobody paints my house or fixes my car for free. So why do I and so many other people in the “helping” professions feel that there is something wrong for getting paid to help someone overcome a difficulty. Obviously a personality defect.

The owner of the Hypnotherapy Academy of America, wise fellow that he is, recognized this tendency. Attending the school was pretty expensive but a good value because of the very high quality of the education, excellent instructors and complete, clear and easy to use materials.  Tim, the owner and head of the school, made it clear that it was important both for us and our clients to charge a fair amount for our services. We spent some time on this subject, looking at our beliefs about money and discovering if they were helping or hindering us from being successful.  We needed to get reimbursed so we could continue doing what we do and to have a decent level of living which would also serve as model for our clients. The clients need to pay for what they receive, “an equal exchange” so that they would value the service. It turns out that when people have to pay even a small amount for a medication they are more likely to actually take it than if it is free. It appears that at least in some areas of life, free = no value.

I know that when I help someone achieve their goal of becoming tobacco free they will save hundreds of dollars a year. There are of course other benefits. So charging an amount equal to a few weeks’ worth of poison delivery devices seems like a great deal.  Although I know this on the intellectual/conscious level I still have to practice this in my professional life, in both Hypnotherapy and Physical Therapy. I could use another session on this myself.

There is such a thing as going too far the other way. There are hypnotherapists who are all about money with systems to identify all of these areas in which a client “needs” sessions. This can come to over a thousand dollars. Then there is all of the canned CDs or downloads you can recommend. I ended up spending a lot of money to one of these operations to improve my business and before becoming completely turned off, feeling both pressured and disgusted. I am aware that this attitude of trying to squeeze the most money possible from the people you are supposed to be serving also exists in some PTs, MDs, DCs, dentists and hospital administrators.

I really like to see a person for just a few, sometimes one session with the client having the tools to help themselves and hopefully so happy that they become my best referral source and advertisement. It’s a crazy business plan. Maybe it‘ll work.

 

I’ll be attending a hypnosis conference called HypnoThoughts Live in Las Vegas, July 18 – 20. This gathering is for entertainment hypnotists, hypnotherapists and anyone with an interest in hypnosis. Although I don’t do entertainment hypnosis it is fascinating and fun to watch when performed by master show people. There looks to be a great variety of interesting lectures and presentations. This may be blog material you’ll soon be seeing.

Learning Experiences: Goals are important Part 2

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Clear goals, Where’s the goal? Is there a goal here, somewhere else, anywhere?

Usually I have at least a bit of a phone or face to face conversation before setting up an appointment. One time however I got a call from a woman who said that a guy that I had helped thought I could help her.” Well that’s great!  What would be the best day for you to come see me?” I probably said something like that. The man that made the recommendation had some clear goals that he wanted to achieve. We worked great together, he did his homework and he was much happier with his life. Unfortunately by not having “the talk”, I did not discover that for my new client there were no goals that she wanted to address. She was just very unhappy, didn’t really want to talk and wasn’t sure why she was seeing me. It was probably the longest session of my hypnotherapy career. Must have been something wrong with the clock.

There was this other time a few years before. A man with self reported Asperger Syndrome made an appointment to see me but as the session progressed there just wasn’t a clear goal. I couldn’t get him to come up with a specific issue. He knew he wanted to do something with his life but there really didn’t seem to be any direction to that journey. It was a conversation about something, some things, never anything concrete or focused. So we ended up with the generic, but still useful visualization, stress reduction, focus and relaxation techniques. And somehow I didn’t even get paid. I can’t remember what the excuse was. Whatever it was it wasn’t too clear.

 

Hidden Goals

A couple of years ago I had a client who I found extremely challenging. The story got very complicated very quickly. Because of the nature of the situation details will be kept to a minimum. A woman, well into her twenties contacted me for regression to work with abuse she experienced earlier in her life

I carefully explained that the use of regression under hypnosis in this setting is to recognize the feelings and beliefs about oneself based on the previous events that may be having a negative effect on her life now. This allows those ideas to be examined and if not accurate, can be changed to a more positive self-view. For instance if she was blaming herself for being abused as a minor and experiencing guilt, that could be identified and a more accurate assessment could be made, perhaps what happened was not her responsibility but the action of an adult beyond her control. In the process the facts or history do not change only the personal beliefs and judgments about that history. I emphasized that anything that might come from a hypnotic regression session would not be considered legal evidence.

(I’m pretty sure that is true. I’m not an attorney but I’ve watched lots of Perry Mason, Matlock, Night Court and Law and Order. I haven’t seen Judge Judy but I do know from legal ads on TV that I can sue for damages from the effects of some drug that I’ve never heard of even if it resulted in my death. Ah justice.)

After seeming to acknowledge all of the above, the client then indicated that she wanted to recover memories of what had happened to her because she was pursuing legal action and that information would help her case. I repeated everything that had just said about the uses and limits of hypnotic regression. I then asked if under those conditions, she would like to proceed if the outcome might be an improvement in her self-image and the quality of her life but would not be of any use legally. She kind of said that she’d like to try. I did have her experience the breathing, visualization and being present techniques. The trance part of the session was kind of successful in that there was no regression but at least she got to a peaceful place. The woman did want to do another couple of sessions. I’m not sure if we actually met for one or two more sessions. My client had a hard time showing up for or perhaps remembering the appointments she had made.  I never got paid for those sessions. Maybe if she gets a settlement but I’ll still pay the rent in the meantime.

It seems that when I don’t get paid for a session it is a sign that things just aren’t clear. That’s been a learning experience for me.